September 2001

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History: This 71 y. o. white female presented with a seven month history of progressive swelling and erythema of the right face which was beginning to affect her vision. There was no associated pain or pruritus over the affected area. A recent head CT, chest x-ray and opthalmologic and ENT exams were all negative. She had no recent fevers, nausea, vomiting or pain and her past medical history is significant for colon cancer treated by partial colectomy three years prior.


Physical Exam: The patient had extensive induration and erythema of the right neck, cheek, periorbital skin and forehead with impressive edema of the right lower eyelid (Figs. 1,2). There were firm erythematous nodules extending to the parietal scalp. To a lesser extent, she had pink, scattered, indurated patches on the left cheek. There was no appreciable cervical, supraclavicular or axillary adenopathy.

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